Liver diseases account for around 4% of global mortality and remain a major public health challenge. Given the limitations of causal therapies, supportive treatment, including herbal preparations, plays an increasing role. Sylimarol, containing silymarin from milk thistle (Silybum marianum), is one of the most extensively studied agents in this group. Silymarin exerts antioxidant, anti-inflammatory, and antifibrotic effects, with phospholipid formulations offering improved bioavailability. Clinical studies confirm its benefits in metabolic associated liver diseases (MASLD), alcoholic-associated liver disease (ALD), and drug-induced liver injury (DILI), although evidence on survival remains inconclusive. Quality assessments have demonstrated the superiority of registered medicines over dietary supplements, many of which failed to meet standardisation criteria. With a favourable safety profile, Sylimarol occupies an established place in supportive hepatology, while further multicentre studies are needed to clarify its impact on clinical outcomes.